General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences - University of Turin, corso A.M. Dogliotti, Turin, Italy.
Ann Surg. 2016 Nov;264(5):871-877. doi: 10.1097/SLA.0000000000001775.
To evaluate the long-term effects of laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on gastroesophageal function.
LRYGB is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GERD). However, long-term instrumental evaluations of GERD after LRYGB are not available.
Morbidly obese patients selected for LRYGB were included in a prospective study. We performed clinical evaluation with GERD-HRQoL questionnaire, upper endoscopy, esophageal manometry, and 24-hour impedance pH (24-hour MII-pH) monitoring preoperatively and at 12 and 60 months after surgery. This trial is registered with ClinicalTrials.gov (no. NCT02618044).
From May 2006 to May 2009, 86 patients entered the study and 72 (84%) completed the 5-year protocol. At preoperative 24-hour MII-pH monitoring, 54 patients (group A) had normal values, whereas 32 (group B) had diagnosis of GERD: 23 had acidic reflux, whereas 9 had combined reflux [acidic + weakly acidic reflux (WAR)]. The groups were similar in preoperative age, body mass index, and comorbidities. At 12 and 60 months, significant improvement in questionnaire scores was observed in group B patients. No manometric changes occurred in both groups; 24-hour MII-pH monitoring showed a significant reduction in acid exposure, but an increase of WAR in both group A (from 0% to 52% to 74%) and group B (from 35% to 42% to 77%). At long-term follow-up, esophagitis was found in 14 group A (30%) and in 18 group B patients (69%) (P < 0.001).
LRYGB allows to obtain an effective GERD symptom amelioration and a reduction in acid exposure. However, 3 out 4 patients present with distal esophagus exposure to WAR.
评估腹腔镜 Roux-en-Y 胃旁路术（LRYGB）对胃食管功能的长期影响。
LRYGB 被认为是肥胖合并胃食管反流病（GERD）患者的首选减重手术。然而，LRYGB 后长期评估 GERD 的仪器检查尚未见报道。
选择接受 LRYGB 的病态肥胖患者纳入前瞻性研究。我们在术前、术后 12 个月和 60 个月进行了 GERD-HRQoL 问卷、上消化道内镜、食管测压和 24 小时阻抗 pH（24 小时 MII-pH）监测的临床评估。该试验在 ClinicalTrials.gov 注册（编号：NCT02618044）。
2006 年 5 月至 2009 年 5 月，86 例患者入组该研究，72 例（84%）完成了 5 年方案。术前 24 小时 MII-pH 监测中，54 例（A 组）结果正常，32 例（B 组）诊断为 GERD：23 例为酸性反流，9 例为混合性反流（酸性+弱酸性反流[WAR]）。A 组和 B 组在术前年龄、体重指数和合并症方面相似。在术后 12 个月和 60 个月时，B 组患者的问卷评分均显著改善。两组患者的食管测压均无变化；24 小时 MII-pH 监测显示酸暴露显著减少，但 A 组（从 0%增加至 52%再增加至 74%）和 B 组（从 35%增加至 42%再增加至 77%）的 WAR 均增加。在长期随访中，A 组有 14 例（30%）和 B 组有 18 例（69%）患者出现食管炎（P < 0.001）。
LRYGB 可有效改善 GERD 症状和减少酸暴露。然而，4 个患者中有 3 个仍存在远端食管接触 WAR。
